E UROPACE
Conclusion: Atypical AFI are related to individually varying reentrant circuits. Three-D electroanatomic mapping is useful in unveiling complex reentrant
circuits in this group of pts. Mapping guided radiofrequency ablation yields a
high success rate.
I
Al 4 5
RELIABILITY
OF AN ELECTROCARDIOGRAPHIC
SIGN
TO PREDICT BIDIRECTIONAL
ISTHMUS BLOCK IN
ATRIAL FLUTTER ABLATION
V. Ducceschi, R. Sangiuolo’, R. Citro, N. Briglia’, M. Santoro, R. Calvanese’,
V. Sepe’, G. Gregorio. U.O. Utic-Cardiologia,
Ospedale San Luca, ASL SA3.
Vallo Della
Lucania
(SA); * Ospedale
Bum
Consiglio,
Fatebenefratelli,
Al 4 6
W H A T IS THE APPROPRIATE END-POINT
TYPICAL ATRIAL FLUTTER ABLATION?
@<0.002). At the line of ablation we observed double potentials with the
time avg. 113.0&35.5 ms. In the other 13.3% patients with the recurrent of
arrhythmia we observed double potentials with the interval avg. 71.9&9.9 ms
@<0.05), the bidirectional isthmus block and significant difference between
A potentials for LRA~T (1) = 39.9&15.5; (2) = 10.8&8.5 only (p<O.O04).
Conclusions: 1) the appropriate end-point of the typical atria1 flutter ablation
is bidirectional isthmus block 2) the estimation based on a sequence of the
depolarization only after ablation is not sufficient for the succesful ablation;
any additional measurements have to be done to the correct end-point of the
procedure
Napoli
Aim of the study: to awas the reliability and predictive accuracy of an electrocardiographic (ECG) sign to predict bidirectional cave - tricuspid isthmus
block (BIB) in atria1 flutter ablation (AFIA).
Methods: 81 ansecuitve patientz (46 M and 35 F, mean age 64 years, range
32 - 80) were referred to OUTInstitutions to undergo radiofrequency (RF) AFlA
for recurrent episodes of paroxysmal or chronic AA. 27 patients also suffered
from paroxysmal or persistent atria1 fibrillation. RFA was performed during
sinus rhythm or atria1 flutter, placing a decapolar or duodecapolar catheter
along the right atria1 perimeter, a quadripolar catheter in the His bundle region
and a quadripolar or decapolar catheter in the coronary sinus and an 8 Fr - 8
m m ablation catheter on the cave - tricuspid isthmus. The last 25 procedures
were performed using a 3D electro-anatomical mapping system (RPM, Boston
Scientific) in order to furtherly validate with activation and voltage maps the
reliability and the accuracy of the nouvel ECG sign to predict BIB
Results: BIB was achieved in 79181patients (97.5%). In two patients, despite
several RF erogations, only a counter-clockwise unidirectional isthmus block
was amenable (i.e. pacing from the infero-lateral right atrial wall (RAW) and
not from the coronary sinus ostium, CS OS). In the remaining 79 patients, the
occurrence of BIB was characteristically associated with a typical alteration of
P wave (PW) morphology that was overt during pacing from CS OS
W h e n isthmus conduction was intact, pacing from CS OS disclosed a completely negative P W polarity in the inferior ECG leads. After obtaining BIB, in
all the 79 patients pacing from CS OSrevealed a modification in P W morphology characterized by an upright terminal portion in the same ECG leads. This
was also confirmed when activation and voltage maps with RPM system were
performed.to validate BIB.
Conclusion: An upright terminnal portion of P W in the inferior leads during
pacing from CS OScan be considered a reliable and very accurate nouvel ECG
sign of BIB. This ECG sign may be related to the “forced” crania-caudal
activation sequence of the lateral R A W that is disclosed by pacing from CS OS.
I
2003
A15 ADVANCES IN VASO-VAGAL SYNCOPE
IAl
5 1
PULSE W A V E ANALYSIS INDEPENDENTLY
DISCRIMINATES
BETWEEN SUBJECTS WITH
RECURRENT VASOVAGAL SYNCOPE AND HEALTHY
CONTROLS
.I. Simek, D. Wichterle, V Melenovsky, L. Rychly, .I. Ma&, S. Svacina. 3rd
Dept. of Internal
Republic
Medicine,
General
University
Hospital,
Prague,
Czech
Purpose: W e investigated whether vasovagal syncope (VVS) is associated with
increased large artery stiffness using recently described index of digital pulse
wave contour.
Methods: Finger arterial pressure (FAP) waveforms (Finapres) were obtained in 20 head-up tilt test positive subjects with recurrent VVS (13 women,
aged 39.5&13.7 years) and in 20 sex and age-matched healthy controls. Recently introduced index of large artery stiffness (SI) was calculated as a ratio
of subject height and time delay (dr) between the systolic and diastolic peaks
of the FAP waveform (see the figure). Both groups were compared by unpaired
t-test.
Results: Compared to the control group, patients with VVS had signficandy lower dT (291.4&28 ms vs. 328.9&X3.7 ms, p = 0.000014) and higher
SI (5.95&0.76 m/s vs. 5.19&0.4 IQ/S, p = 0.00033). This difference remained
significant after controlling for body mass index, mean heart rate, and mean
arterial blood pressure (ANCOVA): p = 0.00058 and p = 0.006 for dT and SI,
respectively.
OF THE
D. Kozlowski, M. Gawrysiak, W. Kmpa, E. Ko Luk, P. Derejko, G. Opolski,
G. Wiytecka, .I. Kubica. 2nd Department of Cardiology, Medical University of
Gdamk
Department
of Cardiology and Internal Medicine, Medical University
of Bydgoszcz, Department of Cardiology, Medical University of Warsaw,
Poland
Typical atrial flutter (A%,)
is an arrhythmia based on macro-reentry phenomenon. The special area so called cm-sinus-tricuspid has become a target
site for ablative therapy, which is the treatment of choice in typical atria1 flutter.
This procedure is performed by linear lesion, what allows stopping of the
macroreentrant circuit running within the walls of the right atrium. However
during the procedure a lot of applications should be delivered, but effectiveness
is less than a half of cases. The aim of the study was to analyze the intracardiac
recordings before and just after ablation.
W e analyzed 60 electrophysiological studies patients with A&,
(age ranged
45-79 yrs, avg. 63.5&10.1 yrs; 14F, 46M). All patients underwent isthmus ablation as a critical point of conduction (S-60 application, avg. 19.7&17.3). W e
measured the sequences and timing [ms]: HRACSP (l), HIS-CSP (2) HRA
LRA (3), HIS-LRA (4) during the pacing of LowRA &R.&j and ProksimalCS
(CSPsT,l just before and after ablation.
W e stated that, before ablation 36 patients (with sinus rhythm)
have opened isthmus - LR.&(LRA+HRA+CSP+HBE)
and CSPsT
(CSPi-HBEi-LRAi-HRA);
the d’1ff erences between the A potentials
were as follows: LRAsT (1) = 34.0&24.3;
(2) = -0.87&15.2,
and for CSPsT
(3) = -35.9&22.9; (4) = 44.4&25.3. In 24 patients (with permanent atria1
flutter) above masurements were impossible, critical point of conduction
using concealed enhainment was obtained. After ablation in 86.7% patients
with stable effective procedure we obtained bidirectional isthmus block:
LR.&(LRA+HRA+HBEiCSP)
and CSP~T (CSPi-HBEi-HRAi-LRA),
the differences between A potentials were: LRA~T(~)
= 88.4&31.4;
(2) =
53.4&30.6, and CSP~T (3) = 26.5&125.5; (4) = 86.6&32.1 respectivelly
B22
Europace Supplements,
Vol. 4, December 2003
Conclusions: Our results support the hypothesis that increased large artery
stiffness is a powerful predisposing factor for vasovagal syncope. This observation might have wider clinical implications, because the time delay between the
systolic and diastolic peaks can be measured simply and rapidly by inexpensive
photoplethysmograph devices.
IAl 5 2
CEREBRAL VASOCONSTRICTION
IN
NEURALLY-MEDIATED
SYNCOPE: RELATIONSHIP
WITH TYPE OF HEAD-UP TILT TEST POSITIVE
RESPONSE
S. Silvani’, G. Padoanz, A.R. Guidiz, G. Bianchediz, A. Mar&a’.
*Cardiology
Division,
Ravema, Italy
‘Neurology
Division,
S.Maria
Delle
Croci Hospital,
Background: The pathophysiology of neurally mediated syncope (NMS) is
unclear. Cerebral vasoconshiction has been observed in NMS patients during
tilt test. To shed light onto NMS pathophysiology, we investigated whether the
degree of cerebral vasoconstriction changes with the positivity type of tilt test,
scored following Sutton’s classification.
Methods: 19 patients (10 males and 9 females, age 41&15 years) consecutively admitted to tilt test evaluation were studied with simultaneous recordings
of electrocardiogram, blood pressure, electroencephalogram (EEG) and Tmscranial Doppler Sonography (TCD) of the middle cerebral artery. TCD allowed
computation of Gosling’s Pulsatility Index (PI = systolic-diastolic/mean veloc-